08020109 CITY OF CUPERTINO = * % ," -;uf 'x^.L -
BUILDING DIVISION PERMIT pCEINTW'j&0 Wvo, II�TFORM
AT,IOIV
PERMIT NO.
But PERMIT DR TBD — TO BE DETERMINED 08020109
1.R''S�INAME; ME1IV PERMIT `LSUE DAIS
LAI JACK K AND GLORIA H 06/02/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHIIECnENGINEER: ,
BUILDING PERMIT INFO
' BLDG ELECT PLUMB METH
000 LICENSED CONIRACfOR'S DECLARATION Job Description
w 1 bercby affirm Nn 1 1 am licensed under provisums of Chapter 9(commencing P
.0 wiNScetion'IIX1(1)ofDivision3oftheBusixvandPrafessloruCode,andmylicenxu NEW INLAW UNIT-784SQ, 24SQ PORCH, 548SQ ATTACHED
m in fun force and creat
j 2 b License Class Lic.a GARAGE.
;:9 Dau Contractor
e ARCHITECTS DECLARATION
Wz 1 undersand my plane mall M used as public ramNa
W
y o Licensed Ptafcssmal
OWNER-BUILDER DECLARATION
a� f I Wreby afro that 1 am exempt from the Contractor's License Law for case '
ZOO fallowing reamn.(Section 71D 1.3.Business and Professions Code:Any city or county
52 ff which requires a permit m cowrm,alter.improve.demaRN,or repon my consume
-it„' poor to its issuance.also requires the applicant forsuch Permit to rile a signed suument
ss< tlwhculiccnxdpurmentmNeProvisions ofduConuazla
tor'sUccronw(Capur9 Sq.Ft. Floor Area Valuation
RN (commencing with Section 7W0)of Division 3ofNCBusiness and Professions Code)or $160000
5- that he is exempt Nwefr ad and the bass,for the alleges exmpuon.Any Holati.of
Section 7031.5 by any applicant for a permit subjects the applicant so a civil penalty ofNumber Occupancy
set mart Nan five hundred dollars(SMI. 32645010 .E Pane Y Type
01,as covens ofUx Property,or my employees with wages as them to eampenauos.
will data work and to structure is not intended or offered fora sin(Sec.7041ul,Bannon
and Professional Cade:The Communes Lt.law does but apply w an no,of Required Inspections
property whobuildsairepromsthereon,and wW dmssmh work himself orthrough his
own employees,provided dmisech improsemenu are not intended oroffered forsale It.
however.the building or improvement is sold within one you ofcompleuan.the owner.
builder will ave the l u ben of Proving that be did not build or improve for purpose of
ale.I.
I,as owner of she property aro esclasivcly connecting with licensed contractors a
mnsrroet the protect(Sec.7014,Businessand Pru(asions Cade:)The Coouaemr'a Li-
:I •law docs not apply he an owner of property who builds or improv Neeson.and
w W convuu Icer such WK^ ss+with•conugctor(s)IiaveO pursuant a the Contractor's
Lice am Law.
ea to ee ,BkPy'or 'a reapsIV., L/J
WURKleR'S COMPENSATION DECLARATION
1 thereby grim under penalty of perjury one of the following decimations:
❑Ih:+eand willmunaina Ceniriate of Conscntmxlf-insurtfcWaher'sCompen-
colon,as provided for by Section 5700 of to labor Code,for to performance of the
wank for which Nu Permit is issued.
❑I have and will mnnuin Worker's Compenedion Iowan¢,as required by Section
37M o(dte labor Code,for the performance ofthe work for which this Permit is issued. '
My wmoter'a cmepewtion Wer.area and Policy numbs>R:
Career. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Tbs,acctirst need not W completed if Ne Permit is forum hundred dollen($1011)
or test)
1 coolly Nat in the performance of tW work far which Nis Permit B issued.I call tut
employ any person in mymanmrm u me b' b thewotrss'Compensauon
Laws of California.Dvu
A,,iiam -
NOTICE TO APPLICANT.If,after hong this Cediftcate Eacmpton,you should
becmme subject so the Workers Compensation provisions of Na labor Coale.you man
0 z foMwith comply with such Provisions or this permit shall W deemed revoked.
'Z7)' CONs1RUCn0N LENDING AGENCY
Fvim-, l amby aRm than there s,a construct.tending agony far the nerfemartmuf
15: ti
the work for which shot Permit is lasned(Sec.3097,Civ,C)
0 Lender's Name
,7 z Lender's Address
U O 1 sonify that 1 ave road Nis appliation and sues that the above information is
Vk ^F comet.I agree lm comply wish all city and county ordinances and sues laws relating a
0 U Wilding conswctim.and hereby.wWrine nPrexnatires ofNs,city N orwope.she
4 save-.liabilities,
or.coy for inspection Purpaxa
(We)agree to save,indemnify and kap armless de,City of Cupenim all
ti to incoitolunes of the
costs;and espensesmit. may in any way accrue against said City
U z A APPLICANT
oNDERST FDS Nu permit.
^ APPLICANT UNDE DS ANggq---NNwsglByy,L COMPLY WITH ACL NON-POINT Issued by: Date G'�2z�
SOURCE REGUI I ONS,. r--4-� ()/.. !u�j
lJ "f I'- Re-roofs-
Stgnoum of AppliaHAZA HAZARDOUS
Date -
FIAZAADOUSMATERIALS DISCLOSURE Type of Roof '
Will Ne appliant or fmure building eccupmt am mbandle hamnlow material
Mcd by tite CupeNm Municipal Code.CaPter 9.17.and the HaIN and Safety
.section 25552(.)T All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
wn the.applicant or future building mace ant ax If a�roof is installed without first obtainingan inspection,I agree to remove
OD g P equipment or devices which P
emit harardnw air conamiants ss dcflmd by the Bay Area Air Quality Management all new materials for inspection.
Duorina
❑Yes u
I have read the hvardousmate Isla mquirematsumkr Chapter 6.95 of Ne Calif.r-
his Health hSafetyCmde.Sections n!X)5.25533 and 25534.1 mdcrsand that if Ne Wilding
des set cumntly ave•coram.shu it u my rcapotuibility m amity the uaupam or Ne
roquirt hichmwtW L ' rwissumaof.certur, to fOc p D Signature of Applicant Date
Owner or edQ Signature
All roof coverings to be Class lW'or better